Health and Social Care Committee
HSC(4)-16-12 paper 4
Inquiry into residential care for older people – Evidence from Care Council for Wales
Cadeirydd/Chair: Arwel Ellis Owen
Prif Weithredwr/Chief Executive: Rhian Huws Williams
Dyddiad/Date: 16.12.11
E-bost/mail: Rhian.jones@ccwales.org.uk
South Gate House
Wood Street
Caerdydd/Cardiff
CF10 1EW
Ffôn/Tel: 029 2022 6257
Ffacs/Fax: 029 2038 4764
E-bost/mail: info@ccwales.org.uk
Wefan/Website: www.ccwales.org.uk
The Clerk to the Health and Social Care Committee
National Assembly for Wales
Cardiff Bay
CF99 1NA
Dear Sir/Madam
Care Council for Wales’ Response - Inquiry into residential care for older people
Thank you for the opportunity to provide evidence to the inquiry into residential care for older people.
1. Background - Care Council for Wales
The Care Council for Wales (Care Council) is the regulatory body for the workforce in social work and social care. The Care Council has the statutory remit to register and regulate the social workers and social care managers and workers and regulates their education and training. It is also has the remit for workforce development and planning.
The Care Council’s primary responsibilities focus on improving public protection through:
· promoting high standards of conduct and practice in the workforce; and
· promoting high standards of training.
The Care Council is a modern regulatory body, set within the context of devolution and one which tackles public protection in a different way, with accountability to service users and carers. The Care Council membership has already made a reality of the full involvement of lay people, carers and the users of services in its governance and throughout all aspects of its work.
The membership of the Council, its Committees and its regional social care partnerships has provided the Care Council with a mechanism to work in partnership with the sector. This enables us to link with the public, independent and third sector. Our role in delivering the Sector Skills Council (SSC) remit for Wales has required us to have good employer engagement and information which we access at national and regional level. This approach has meant that standards, qualifications and practice guidance have been developed in partnership with the sector.
The Care Council works at a national, regional and local level with partners providing information and ensuring that the sector is aware of our actions and work with us in the initiatives we take forward. The Care Council has a key role to support the delivery of ‘Sustainable Social Services: a framework for Action’[1] in leading and driving the step change for confident competent practitioners, moving beyond minimum standards to a continuing professional education and learning model.
There are raised expectations of practitioners, and raised aspirations for what practitioners need if they are to be confident professional practitioners. One of the key levers for change will be the focus on the leadership role of managers in residential care for ensuring the quality of practice and practitioners.
We welcome the opportunity to contribute to the inquiry to examine the provision of residential care in Wales and the ways in which it can meet the current and future needs of older people. Our response will focus specifically on the workforce, and on areas where we have specific information to provide to the enquiry. We will therefore be responding to specific questions only.
2. The Response
The process by which older people enter residential care and the availability and accessibility of alternative community-based services, including reablement services and domiciliary care.
Providing accessible community based care will be at the heart of taking forward the vision for citizen centred services contained in Sustainable Social Services: a Framework for Action. It is important that strategic work is done to look at the workforce implications of new models of alternative community-based services including domiciliary care and reablement.
New models of community based services have emerged which may increase the range of options available before a person enters residential care. Notable examples of these include the development of telecare, new roles such as Health and Social Care Support Workers and services designed to provide advice, information and support at an early stage.
There has been a particular emphasis on reablement services in recent years and this is now increasingly mainstreamed by Local Authorities, and residential care homes increasingly may provide community based services e.g. rehabilitation, short term care. In order to ensure success of such strategies and innovations the skills of those who commission them are critical, ensuring services that are fit for purpose and value for money.
Joint Health, Social Care and Well-being Strategies have provided a vehicle for social services and health services to work together with other partners to develop community services, and services and support for carers is an essential part of enabling people to remain in their own homes for longer. Advice and information about services is also crucial as some older people (and carers) may not be aware of the alternatives or may not seek help at an early stage (e.g. self funded older people).
The Care Council contributed to work undertaken by the Welsh Government to develop a Community Services Framework in Wales which was an attempt to map the development of community services and share good practice.
All of the above issues have major implications for the social work and social care workforce to assess the need for, plan and deliver community based services. They also have major implications for leadership and management skills in the social care sector, some of which are referred to later in this response.
The workforce within domiciliary care as calculated for those settings regulated by the Care and Social Services Inspectorate Wales (CSSIW) is employed in 408[2] separate agencies registered with CSSIW across the public, independent and third sector. Each agency is unique and trains and manages its own workforce to meet the specific terms of contract commitments they have at any one time. The size of agencies varies from typically 20-50 workers in small private agencies through to over 200 workers in public sector services.
In 2010 – 11 the statistics show that 3,621,515 hours of home care were provided directly by the local authorities in Wales and 7, 555,306 hours were provided by the independent sector under contract to the local authority.
The data for the whole of the workforce numbers are not available, but the local authority total numbers for employed domiciliary care staff as at March 2011 is 5,995, this accounted for 21% of total staff. In view of the number of hours shown previously it is obvious that the total number of workers employed in domiciliary care services is considerably more.
The ’Care at Home’[3] Study published by the Care Council in 2010 aimed to undertake a study on the care at home workforce and the implications for the workforce of moving towards new ways of working. The project was commissioned to answer three key questions:
1. What does the care at home workforce currently look like?
2. What is the future vision for care at home and its workforce?
3. What do we need to do to move the current workforce towards the vision?
The report was clear that further work was needed to promote the value and make sure the workforce delivering care in people’s own homes or in the community had the skills and knowledge, and were properly supported and managed to deliver the changing service.
The report was also clear that further work is needed to equip and support unpaid carers in their roles. Adaptations and equipment continue to play an important part is assisting people to remain in their own homes, and the important role of the Occupational Therapist was highlighted in this context. “There are a hugely complex set of interactions needed to ensure that the 11.7 million hours of care at home delivered by an estimated 15,500 care at home staff to 25,000+ service users in Wales is sustainable and of high quality. This is in addition to the nearly 300 million hours of unpaid care provided by carers”.
One of the key areas is the skill mix necessary to deliver community based services and within that one of the issues is the balance between health and social care aspects of some of the roles.
The Care Council has been undertaking some key actions following the publication of the report, for example, together with the National Leadership and Innovation Agency for Healthcare (NLIAH) we have identified a range of models which have been developed across Wales and are working toward developing a practice governance framework for the workforce working across health and social care boundaries.
This is in recognition that staff play an important role in service delivery and we depend upon their skills and dedication to ensure that health and social care needs are met in a modern and supportive way. It is critical for sound governance arrangements to be in place to support staff to do the job expected of them, and to ensure that organisations use their resources efficiently and effectively.
Drawing on the results of this report, the Care Council is currently taking forward a range of work which include developments to support the workforce working with older people, including older people with dementia, the work focuses on the priorities of the Welsh Government of people remaining independent as long as possible through receiving appropriate care at home, and also on upskilling the workforce generally to deal with the more complex needs of an ageing population.
Actions are also being taken forward to support the workforce working with carers as well as supporting the workforce to develop outcome focused care through guidance, qualification, units and continuing professional learning and development frameworks. This will ensure that the workforce is aware of and responsive to the needs of carers as well as ensuring that carers are aware of their rights, and what they have a right to expect from social care workers as expressed in the Code of Practice for Social Care workers.
A workforce that has the capacity to deliver the citizen-focused, sustainable services as envisaged in Sustainable Social Services is a primary driver in the current work of the Council. This will be a well qualified confident workforce delivering those services both in the community setting, and in residential care. The Care Council’s works therefore is focused on this and also upon the concept of the professionalization of the workforce in social care generally as outlined in the policy document. “We see the quality of professionals and their professionalism as central to responsive and sustainable social services”.
The Care Council through its Sector Skills Council role has been involved in drawing together Labour Market Intelligence. The need for services generally is predicted to grow, and services for older people will also increase, driven by the demographic changes within society in Wales. Employment growth in the social care sector in Wales averaged 4.2% per year from 2002 to 2008[4]. New work is needed on the impact of the economic climate on the growth which was predicted as being necessary to meet future demand and also the implication on delivering different models of services.
In the recently published UKCES report: Strategic Skills Audit for Wales 2011 ‘Skills for Jobs’[5] thecare and related personal services sector was identified as one of the 10 fastest growing occupations in Wales. This growth has been, and is likely to remain, a key driver in the development of the skills of the workforce within the sector.
The report, which does to some extent class ‘health and social care’ together, also specifically notes however that front line caring personal service occupations, including care assistants are amongst the occupational groups with the largest projected volumes of replacement demand up to 2017. The Care Council is working with Welsh Government to improve the data available on the workforce in social care in Wales as at the moment the information is fragmented and collected by different agencies for a variety of purposes, which is a barrier to workforce planning.
The salary levels of social care workers in Wales is on average £10.49[6] per hour, this figure however includes those managers and senior staff included in the data, and the majority of social care workers working in both residential and domiciliary care services earn close to the minimum wage level or slightly above.
The Care Council through its Regional Social Care Partnerships is taking forward several strands of work linked to recruitment and retention. Recruitment initiatives include the development nationally of Care Ambassadors, who work with young people to extend the knowledge of the sector and its opportunities. There are 80+ ambassadors across Wales, and they are reaching out to areas within schools and colleges especially, that have been traditionally hard to reach areas for the sector. The response thus far has been encouraging, with schools beginning to see the sector in a more positive light and the younger people able to learn more from front line workers about the nature of the work. It is too early as yet to have an indication of numbers entering the sector as a result. We are also working with partners such as jobcentre plus and Careers Wales to provide information for their advisers on the qualities needed to work in the sector, as well as engaging with employers to offer training and opportunities for jobseekers. Outcomes as yet are small but several areas report an increase in interest in the sector
Apprenticeships are available in Health and Social care and Children’s Learning and Development and work continues to develop full time college courses linked to the new Vocational Diplomas to support young learners in particular have time to learn and develop in College and come out with a qualification that equips them to work in the sector.
the capacity of the residential care sector to meet the demand for services from older people in terms of staffing resources, including the skills mix of staff and their access to training, and the number of places and facilities, and resource levels.
Adult Residential Care Homes for Older Adults provided 23,318 places in 702 settings as at September 2011[7]. There are 19,199 people employed in adult residential care across all parts of the sector in Wales[8].
Registration with the Care Council is a mandatory requirement for managers of Adult Care Homes since June 2011, and managers of Domiciliary Care agencies will also be required to register from 2012. There are currently 975 Adult Care Home Managers registered with the Care Council. Information as to how many of these individuals work within older people’s services is currently being collated.
Managers of services are central to the professionalization of services in Wales. Their professional leadership within practice will be a core element in the governance and provision of consistent high quality practice. The sector has a range of required minimum qualifications for staff in all settings. For the future, there needs to be a shift away from minimum qualifications, changing to an ongoing development model where managers and staff continue to develop and train in order to provide effective services for those older people now entering residential care.
The profile of those older people entering residential care has changed over the past years. Those entering residential care have a higher level of care needs and often have health conditions that need an element of specialist skills, the ageing population of Wales and the growing number of people who are living past 85 years will continue to have a growing effect on this trend.
The increase in numbers of older people entering residential care who have dementia is significant (up to one third) and this calls for excellent leadership skills within managers of services, and also specialist skills within the workforce. Qualification and training for the workforce is central to excellence in provision, as is ensuring that qualifications are fit for purpose.
One of the key roles of the Care Council to date has been to make sure that the qualifications (which are competency based) are up to date so that they qualifications can be used as a marker of standard achieved. The Care Council has therefore been integral to the development of the new qualification framework for Wales, England and Northern Ireland, The Qualifications and Credit Framework (QCF), offers greater clarity and flexibility in the qualifications that are available to the workforce.
The qualifications and units enable people to build on their achievements in a formally recognised way, by taking a whole qualification or accredited units for their continuing development. The units have been written in a clear language and style that will assist learners, employers and assessors to identify the relevant units for their needs.
The development of the qualifications has involved a great deal of partnership working between employers, learning providers, subject experts who may be service users, carers or service providers, awarding organisations and sector skills council partners. For example the qualifications in health and social care have been jointly developed by Skills for Care and Development and Skills for Health and will be part of the shared Apprenticeship frameworks in Wales. This development will ensure that those individuals working across sectors have common understanding and competence to provide care that is needed in both health and social care for example. This will ensure that there is less duplication of service as workers are competent to provide specialist skills across sectors. What is the benefit of this and how will it help to ensure high quality practice and sustainability?
All the qualifications are based on National Occupational Standards. (NOS). These are benchmarks of performance. They provide the means for assessing performance in a job: they are work-related statements of the ability, knowledge, understanding and experience that an individual should have to carry out key tasks effectively. Most of the units that form part of the new qualifications are based on the relevant National Occupational Standards. Where there has been sector engagement in other specific areas, additional units have also been developed, e.g. for dementia care.
Sustainable Social Services notes that “Significant parts of the infrastructure to support service delivery, such as staff development and training, will need to be organised more collaboratively”. The Care Council’s role in this important work will be two fold; in terms of leading a new approach to ensuring that there is accessible learning and also for regulating the quality of that learning for social workers in the future. For other workers within social care, the Council has an important role in ensuring that there is confidence in the quality and appropriateness of the training and learning for managers and for social care workers.
The quality of residential care services and the experiences of service users and their families; the effectiveness of services at meeting the diversity of need amongst older people; and the management of care home closures.
An effective well qualified workforce is central to quality of services in residential care, it is interesting to note a recently published research study which concluded that that residential care homes with a higher proportion of qualified care staff provide better outcomes for residents[9]. The study found that where a greater proportion of staff had, or were working towards qualifications, resident outcomes were better. Structural issues such as how homelike the environment, were also better where more staff had or were working towards a qualification.
The recent reform of qualifications also aims to contribute to providing a diverse range of learning which provide staff and managers with the appropriate mix of knowledge skills and values. For example a specific unit on caring for individuals with dementia which focuses on enabling rights and choices of individuals with dementia whilst minimising risks, will provide learning that will ensure an understanding of key legislation and agreed ways of working that support the fulfilment of rights and choices of individuals with dementia while minimising risk of harm and maximise the rights and choices of individuals with dementia, as part of the learning outcomes.
The Care Council is also taking forward initiatives which focus on specific needs of older people in Wales, with a particular focus on language need, to this end; work is going forward on assessing the language skills of the workforce in Wales through a regional initiative from the Care Council.
Work is being developed with CSSIW as part of our new approach to regulation which will focus on clarifying the measures for good quality care in residential care and within that there will be focus on the new leadership requirements of managers as leaders of good quality practice,.
Sustainable Social Services requires that an explicit link is created between the providers of services registered with CSSIW and the professionals working within those services who are registered with the Care Council.
The Care Council and CSSIW have therefore been working on the development of a programme of work to strengthen collaboration between the two organisations in order to achieve this aim. The two organisations are working together to ensure that there is stronger data and information on the service provision and the workforce which provides robust evidence on current quality and on improvement needs.
The effectiveness of the regulation and inspection arrangements for residential care, including the scope for increased scrutiny of service providers’ financial viability.
The Care Council and the Care and Social Services Inspectorate (CSSIW) are two essential, independent and equal parts of a regulation, inspection and quality improvement system, which is designed to improve the experience and outcomes for people who use social services in Wales.
Currently the Care Council’s model for regulation of the registered workforce is one where individual complaints are received or issues raised, the Care Council then responds to these according to procedure. These include the investigation of appropriate issues, the holding of formal conduct hearings, and ultimately the removal of an individual from the register. Removal means that those individuals will not be able to work in the sector with vulnnerable people. The general issues that these highlight are then assessed and any trends which are apparent are addressed through one of several methods. For example practice guidance may be developed, or general training needs highlighted, or the issues may be raised for discussion with CSSIW.
Mandatory registration only applies to the managers of Adult Residential services. The Adult workforce can be voluntarily registered with the Care Council, but as recent experience has shown, when difficulties arise with their conduct, even their suspension from the register will not necessarily result in their being unable to work within social care. There is real concern about the growth in the numbers of referrals from the Police Authorities in Wales about care workers not registered with the Care Council. Since January 2011 we have referred 20 non registered workers to the Disclosure and Barring Service.
The Care Council and the CSSIW have worked together on a shared purpose to improve the experience and outcomes for people who use social services in Wales. The outcomes of the shared agenda are that:
· the quality of services in Wales is improving;
· Wales has a safer, more skilled and flexible social service and social care workforce;
· Wales has an effective, proportionate and successful model of regulation in social services and social care services;
· the people of Wales understand the quality of service they should expect and have a good experience of service centred on their needs, rights and risks; and
· the work of both organisations is regarded as international exemplars of good practice and innovation.
The Care Council and the CSSIW have been examining individually and together how best to refocus regulation of people, training and of services and also service inspection to support the delivery of sustainable social services “which are safe and effective people centred services that build on people’s strengths and promote their well being”.
These discussions have also included considering the key characteristics of high quality managers as well as those characteristics and indicators of workplaces which support high standards of management practice. Both organisations recognise the need for change and welcome the opportunity to examine how best to build on what is working well and grasp the opportunity to put in place improved arrangements where necessary. Individually the two organisations have been modernising their regulatory arrangements in the light of experience and the need for change. Together we have been working on the development of a partnership approach which will enable us to focus on improved outcomes for people who use services through our shared commitment to improvement and safeguarding by:
· Reducing duplication
· Ensuring consistency
· Identifying the potential of shared resources and expertise
· Developing a more powerful voice based on shared evidence and intelligence
· Increased value added
·
Increase public
understanding of our shared objectives but different roles.
The intention is to have clear transparent and accessible
information on the standards which can be expected of services and
of people and on what currently meets the standards.
Beginning in June 2011, those managing residential care for adults must register with the Care Council for Wales to practice as an Adult Care Home Manager. This mandatory registration will mean that from this date it will be an offence to practice as an Adult Care Home Manager in Wales without registration (subject to transitional provisions in respect of enforcement)
Whilst on the Register, managers have a responsibility to uphold and maintain the standards of conduct and practice that are contained within the Code of Practice for Social Care Workers When a registered social care manager does not meet the standards set in the Code, the Care Council can take action.
Manager registration will also provide the Care Council with intelligence regarding trends within the workforce, enabling an early recognition of development needs both within managers and their staff. The Council is working toward creating a positive relationship with these new registrants with the aim of understanding and reflecting their priorities and future needs in professional development and workforce leadership.
In the recent Forums held with Managers in Adult Residential care, by the Care Council to discuss their own Learning and Development, managers welcomed the opportunity to contribute to their own development and emphasised the value of shared learning and mentoring. They identified issues of leadership, staff supervision, employment law, peer group learning and dealing with complexity, to name only a few. This information will provide the Care Council with a steer as the funding bid for the Sector Leadership fund is taken forward. This bid to the ESF focuses on the sector specific leadership learning needed by managers in social care in Wales. It will be a significant asset to professionalization through leadership skills if successful.
New and emerging models of care provision.
The skills of the workforce providing social care within any model of care provision are central to the quality and success of that provision. Changes in demographics and in resource would suggest that those skills will be focused on working with long term illness or conditions, and mainly within communities.
Integrated care across boundaries which provide service users with a strong voice and control over the services is the objective of the policy currently being taken forward in Wales. The social worker and the social care team will need to be a means of enabling people to make the changes they need in their lives. The role of a professional workforce that is able to support carers as well as service users and also able to deliver services which will in the future entail a greater use and understanding of technology cannot be underestimated.
Skills for Care and Development is the UK sector Skills Council for Social Care and Children’s workforce of which The Carer Council for Wales is one of six partners. The Care Council takes forward the SSC’s work in Wales, and is part of its UK governance. The SSC has succeeded in bids for funding to the UKCES Employer Investment Fund; this includes two projects making innovative use of new technology. One is using new ways of learning delivery and the other developing skills in the use of assistive technology, e.g. Telecare.
As noted the Care Council is involved in working with the sector on new models of working and identifying the skills needed for the workforce of the future.
The balance of public and independent sector provision, and alternative funding, management, and ownership models, such as those offered by the cooperative, mutual sector and third sector, and Registered Social Landlords.
The social care workforce is changing as people employ their own personal assistants and social care practitioners work for a range of employers across, health social care and housing. This is particularly so in the workforce which will be providing services for older people. Care Council has a track record of bringing people together from a range of different sectors to enable learning and development such as its work with the Common Core of Skills and Knowledge for Children’s workers and the Older People’s Workforce Network brought together to look atthe development of an Older people’s workforce strategy. In 2010, the Network developed a brief over-view strategy / summary of existing workforce strategies as a first step towards developing a "new" strategy for the older people’s workforce. This document provides a ‘one stop shop’ and identifies themes, priorities and gaps.
Care Council currently has a project working within Welsh Government’s Credit and Qualification Framework for Wales to promote Quality Assured Lifelong Learning in Social care and is working with WCVA to explore its value to voluntary organisations. The aim is to ensure workers have the widest access to learning which is required to deliver high quality care to vulnerable people.
The Care Council has also been considering the skills and also public assurance issues which arise from changing models of service and the implications of the increase in people purchasing their own care. The Care Council is currently working toward promoting Quality Assured Lifelong Learning in Social care and is working with WCVA to explore its value to voluntary organisations. The aim is to ensure workers have the widest access to learning which is required to deliver high quality care to vulnerable people
Yours sincerely
Arwel Ellis Owen
Chair